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VILLAGE PEDIATRICS OF CHAPEL HILL, P. A REGISTRATION FORM (Please Print)Today's date:Parents Names:PATIENT INFORMATION Patient last:First:M.I.:Street Address:Nickname:Phone 1: (City:State:Pharmacy:
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Visit the website of Village Pediatrics of Chapel and download the patient registration form
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Fill out the patient registration form with accurate information, including personal details and medical history
03
Ensure that you have all the necessary documents, such as insurance information and identification cards
04
Make sure to sign the form and provide any additional required signatures or authorizations
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Double-check all the information provided to ensure its accuracy
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Submit the completed form either in person at the clinic or through their online submission portal.

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Village Pediatrics of Chapel is a pediatric clinic, therefore it is primarily for parents or guardians who have children in need of medical care.
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Additionally, it can be useful for pregnant women seeking prenatal care or individuals seeking general pediatric consultations and treatments.
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Village Pediatrics of Chapel is a pediatric medical practice located in Chapel Hill.
The owners or operators of Village Pediatrics of Chapel are required to file.
The form for Village Pediatrics of Chapel can be filled out online or in person at the practice.
The purpose of Village Pediatrics of Chapel is to provide medical care to children in the Chapel Hill area.
Information such as patient demographics, medical history, and treatments provided must be reported on Village Pediatrics of Chapel.
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